NPI 1609913318

Southern Pain Institute PC

Organisation Interventional Pain Medicine Physician Conyers, GA

Practice location

Address: 1501 Milstead Rd NE Suite 140, Conyers, GA 30012-3838
Phone: (770) 632-3730
Fax: (770) 632-3731
Mailing address: 1975 Highway 54 W Suite 100, Peachtree City, GA 30269-4794

Authorised official

Name: Anthony T Clavo
Title: Ceo
Phone: (770) 632-3730

Registered specialties

Interventional Pain Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208VP0014X Licence 045425 (GA)

Other Pain Medicine providers in Georgia →

Registry record

NPI: 1609913318
Entity type: Organization
NPI issued: 31 Jan 2007
Record last updated: 30 Jul 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.